Fecal transplant in refractory Clostridium difficile colitis

Abstract

Background: Clostridium difficile infections are becoming more common, more severe, and more likely to recur. Conventional treatment with antibiotics often fails to eradicate the infection; even when it succeeds, recurrent infection is common. Complementary treatment with probiotic agents to reconstitute the physiological intestinal flora does not yield any consistent benefit. In recent years, fecal transplantation has been used in the English-speaking countries with cure rates of about 87%, but the available evidence is limited to large case series. No randomized controlled trials have been performed. We present the case of a 73-year-old woman with intractable, recurrent enterocolitis due to Clostridium difficile who was successfully treated with fecal transplantation via colonoscopy.

Case description: Upon the completion of antibiotic treatment for a second recurrence of enterocolitis, stool in liquid suspension was introduced into the patient's colon through a colonoscope. Prior testing had shown the stool donor to be free of acute infection or stool pathogens. The patient was given loperamide to prolong contact of the stool transplant with the colonic mucosa. She was also treated with Saccharomyces cerevisiae for four weeks.

Course: There was no clinical or microbiological evidence of a further recurrence of enterocolitis for 6 months after transplantation. Stool transplantation had no adverse effects.

Conclusion: This patient had a lasting remission of enterocolitis due to Clostridium difficile after the treatment described above. Fecal transplantation seems to be a safe and highly effective treatment for recurrent Clostridium difficile infection. It is unclear whether the administration of Saccharomyces cerevisiae confers any additional benefit.

Figures

Figure 1

Intestinal ultrasound image of patient described in case report, showing a significant thickening of the intestinal wall and increased vascularization of the transverse colon

Figure 2

Diagram showing course of patient’s illness and treatment; C. diff.: Clostridium difficile; d: day

Figure 3

Preparing and performing fecal transplantation a) Preparation of feces for transplantation by adding 177 g of fresh stool from the donor to sterile saline solution and filtering the suspension through gauze several times b) Application of the filtered stool suspension through the colonoscope tube c) Stool suspension entering the colon

Figure 3

Preparing and performing fecal transplantation a) Preparation of feces for transplantation by adding 177 g of fresh stool from the donor to sterile saline solution and filtering the suspension through gauze several times b) Application of the filtered stool suspension through the colonoscope tube c) Stool suspension entering the colon

Figure 3

Preparing and performing fecal transplantation a) Preparation of feces for transplantation by adding 177 g of fresh stool from the donor to sterile saline solution and filtering the suspension through gauze several times b) Application of the filtered stool suspension through the colonoscope tube c) Stool suspension entering the colon